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Late-term ballgame

Late termination of pregnancy
Other names Postviability ballgame, third trimester abortion, induced termination of pregnancy (ITOP),[1] late-term abortion
Specialty Obstetrics and gynecology
ICD-10-PCS O04
ICD-9-CM 779.6
MeSH D000028
MedlinePlus 002912

[edit on Wikidata]

Belatedly termination of pregnancy (also referred to as late-term ballgame)[2] describes the termination of pregnancy past induced abortion during a late stage of gestation.[3] "Late", in this context, is not precisely defined, and different medical publications apply varying gestational historic period thresholds.[iii] In 2015 in the United States, about 1.3% of abortions took place after the 21st week,[four] and less than 1% occur after 24 weeks.[five]

Reasons for belatedly terminations of pregnancy include circumstances where a pregnant adult female'south health is at risk or when lethal fetal abnormalities have been detected.[6] [7] Later on ballgame is non associated with whatever negative physical or mental wellness outcomes,[eight] [7] and the risk of death following a surgical abortion after 20 weeks is less than that of typical full-term childbirth in the United States.[9]

Late termination of pregnancy is more politically controversial than abortion in general. Most countries in Europe simply permit ballgame in later stages of pregnancy if specific circumstances are present, by and large when the pregnancy represents a serious danger to the life, or to the physical or mental health of the woman, or when a serious malformation or bibelot of the fetus is diagnosed.[x]

Definition [edit]

A late termination of pregnancy often refers to an induced ending of pregnancy after the 20th week of gestation, i.due east. later a fetal age (time since conception) of near 18 weeks. The verbal point when an ballgame is considered late-term, however, is not clearly defined. In iii manufactures published in 1998 in the same issue of the Periodical of the American Medical Association (JAMA), 2 chose the 20th week of gestation and ane chose the 28th week of gestation as the point where an abortion procedure would be considered late-term.[xi] [12] [xiii] The American College of Obstetricians and Gynecologists defines a late term pregnancy every bit 41 weeks 0 days through 41 weeks half-dozen days, which differs from how the term is used in the abortion context.[14]

In the Usa, the point at which an ballgame becomes tardily-term is oft related to the "viability" (ability to survive outside the uterus) of the fetus. Sometimes late-term abortions are referred to as post-viability abortions, though this is non a medical term.[ citation needed ]

Viability [edit]

In that location is no precipitous limit of development, age, or weight at which a fetus becomes viable.[xv] A 2015 study found that even with active treatment, no infants born at less than 22 weeks survived, at 23 weeks survival without astringent impairment is less than 2%, and at 25 weeks, upwardly to xxx% might survive without severe impairment.[16] [17] According to studies between 2003 and 2005, 20 to 35 percent of babies born at 24 weeks of gestation survived, while 50 to 70 percentage of babies born at 25 weeks, and more than 90 percent built-in at 26 to 27 weeks, survived.[18] The American Higher of Obstetricians and Gynecologists and the Social club for Maternal and Fetal Medicine states that in cases of delivery occurring before 26 weeks, "given the potential for maternal and perinatal mortality and morbidity, the pick of pregnancy termination should be reviewed with the patients."[19] Because the chance of survival is variable based on interventions available and the weight and sex of the fetus, at that place is no consensus on viability.

The American College of Obstetricians and Gynecologists reports that 23% of abortion providers offer abortions at 20 weeks of gestation and after, most often using a method called dilation and evacuation (D&E).[20]

Mental health [edit]

Ballgame was shown to behave far less hazard of physical and psychological morbidity and mortality than childbirth.[8] [7] A Consensus Written report Report concluded that in US, abortion does not increase the gamble of experiencing symptoms of depression, anxiety or stress in the curt term or over five years.[21] A previous history of mental health atmospheric condition, sexual assault, and intimate partner violence were strongly associated with experiencing negative mental health outcomes after the abortion.[22]

Incidence [edit]

Abortion in the United States by gestational historic period, 2016. (Data source: Centers for Disease Control and Prevention)

  • Commonwealth of australia: As of 2015[update], South Commonwealth of australia is the but Australian state or territory to keep reliable abortion statistics. During 2012, 92% of abortions were performed earlier 14 weeks' gestation, 6% betwixt xiv and 20 weeks, and 2% (n=96) at a later stage. Of the 96 abortions carried out across twenty weeks, 53 were due to bodily or probable fetal abnormality.[23]
  • Canada: During the year 2019, approximately 87% of abortions occurred by 12 weeks, with one.17% occurring after 21 weeks.[24]
  • England and Wales: In 2015, viii% of abortions occurred after 12 weeks; 0.ane% occurred at or over 24 weeks.[25]
  • New Zealand: In 2003, two.03% of induced abortions were done betwixt weeks 16 and 19, and 0.56% were done over 20 weeks.[26]
  • Norway: In 2005, 2.28% of induced abortions were performed between 13 and xvi weeks, i.24% of abortions between 17 and 20 weeks, and 0.20% over 21 weeks.[27] Between Feb xv, 2010, and December 1, 2011, a total number of ten abortions were performed betwixt 22 and 24 weeks. These have been declared illegal by The Norwegian Directorate of Wellness. Women who seek an abortion after the 12-week fourth dimension limit must employ to a special medical assessment board – chosen an "abortion lath"(Norwegian: 'abortnemnd' or 'primærnemnd') – that will determine whether or not to grant them an ballgame.[28]
  • Scotland: In 2005, half dozen.1% of abortions were washed between fourteen and 17 weeks, while 1.6% were performed over xviii weeks.[29]
  • Sweden: In 2005, five.vi% of abortions were carried out betwixt 12 and 17 weeks, and 0.8% at or greater than eighteen weeks.[30]
  • Switzerland: In 2016, 10% of abortions performed after the legal term were carried out after week 21 (a total of 36 cases).[31] Of these cases 86% were carried out due to concrete problems with the child or mother.[31]
  • United States: In 2003, from data collected in those areas that sufficiently reported gestational age, it was plant that 6.2% of abortions were conducted between thirteen and 15 weeks, 4.2% betwixt 16 and twenty weeks, and ane.4% at or after 21 weeks.[32] In 2014, the CDC reported that 1.3% of reported abortions (v,578) were performed at 21 weeks of gestation or later.[33]

Reasons [edit]

United States [edit]

Reasons for late terminations of pregnancy include when a meaning woman's health is at risk or when lethal fetal abnormalities have been detected.[6] [7]

A written report from 2013 found afterwards excluding abortion "on grounds of fetal anomaly or life endangerment", that women seeking belatedly abortions "fit at least one of five profiles: They were raising children lonely, were depressed or using illicit substances, were in disharmonize with a male partner or experiencing domestic violence, had trouble deciding so had admission problems, or were immature and nulliparous". They concluded that "bans on abortion afterwards 20 weeks volition disproportionately bear upon immature women and women with limited financial resources".[34]

England and Wales [edit]

The NHS records the reasons given for abortions at all stages of development. In 2015, 2,877 abortions were performed at 20 weeks or above, and only 230 of these at or beyond 24 weeks gestation. Of all abortions at 20 weeks or higher up, 23 (0.8%) were performed to save the life of the meaning woman, 1,801 (63%) were performed for mental or concrete health reasons, and 1046 (36%) were performed because of foetal abnormalities.[35]

Legal restrictions [edit]

As of 1998, amidst the 152 most populous countries, 54 either banned ballgame entirely or permitted it only to save the life of the pregnant adult female.[36]

On the other paw, equally of 1998, 49 of the 152 most populous countries allowed abortion without restriction every bit to reason, but 44 of these required specific justification after a particular gestational age:[36]

  • 12 weeks (Albania, Armenia, Azerbaijan, Belarus, Kingdom of belgium, Bosnia-Herzegovina, Republic of bulgaria, Croatia, Republic of cuba, Czech Republic, Denmark, Estonia, French republic, Georgia, Greece, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Mongolia, Kingdom of norway, Russia, Saudi Arabia, Slovakia, Slovenia, Due south Africa, Ukraine, Tajikistan, Tunisia, Turkey, Turkmenistan and Uzbekistan)
  • thirteen weeks (Italy)
  • 14 weeks (Argentina, Austria, Cambodia, Frg, Hungary, Romania and Spain)
  • xviii weeks (Sweden)
  • 22 weeks (North Macedonia)
  • 24 weeks (Singapore, Netherlands[37])
  • viability (to some extent the United States)
  • no limit (Canada, some states in the United states of america, China, and Democratic people's republic of korea)

Dutch Criminal Code defines the "viability" of a fetus to 24 weeks, simply doctors de facto limit on-request abortions to 22 weeks as a margin of error.[37]

Every bit of 2011 amongst those countries that allowed abortion without restriction as to reason, the gestational limits for such abortions on request were: 37 countries set a gestational limit of 12 weeks, 7 countries of 14 weeks, four did not set limits, 3 at viability, 3 at ten weeks, one at ninety days, 1 at 8 weeks, i at 18 weeks, and one at 24 weeks. In addition, Abortion in Australia, and, to a certain extent, Abortion in the United States, is regulated at state/territory level, and laws vary past region.[38]

In these countries, abortions later on the general gestational age limit are allowed only under restricted circumstances, which include, depending on country, risk to the adult female'southward life, concrete or mental health, fetal malformation, cases where the pregnancy was the outcome of rape, or poor socio-economic conditions. For instance, in Italy, ballgame is allowed on request upwardly until 90 days, later on which it is immune merely if the pregnancy or childbirth pose a threat to the woman's life, a risk to physical health of the woman, a risk to mental wellness of the woman; if there is a risk of fetal malformation; or if the pregnancy is the consequence of rape or other sexual offense.[39] Denmark provides a wider range of reasons, including social and economic ones, which can be invoked by a woman who seeks an ballgame after 12 weeks.[forty]

Abortions at such stages must in general be approved by a dr. or a special commission, unlike early on abortions which are performed on demand. The ease with which the doc or the committee allows a tardily term ballgame varies significantly past country, and is oftentimes influenced past the social and religious views prevalent in that region.[ citation needed ]

Some countries, like Canada, China (Mainland only) and Vietnam take no legal limit on when an abortion can be performed.[36]

U.s.a. [edit]

The Usa Supreme Court decisions on abortion, including Roe v. Wade, let states to impose more than restrictions on post-viability abortions than during the before stages of pregnancy.

As of December 2014, forty-two states had bans on tardily-term abortions that were not facially unconstitutional under Roe 5. Wade or enjoined by court guild.[41] In add-on, the Supreme Court in the case of Gonzales 5. Carhart ruled that Congress may ban certain late-term abortion techniques, "both previability and postviability",[42] equally it had washed in banning intact dilation and extraction with the Fractional-Nascency Abortion Ban Act of 2003.[43]

The Supreme Court has held that bans must include exceptions for threats to the woman'south life, physical health, and mental health, just four states allow belatedly-term abortions only when the woman's life is at run a risk; 4 allow them when the woman'south life or physical health is at adventure, just employ a definition of health that pro-selection organizations believe is impermissibly narrow.[41] Notation that just because a portion of a land'due south law is found to be unconstitutional does not mean that the unabridged police force will be deemed unconstitutional: "[I]nvalidating the statute entirely is not ever necessary or justified, for lower courts may be able to return narrower declaratory and injunctive relief," meaning the court could declare that simply those parts of the constabulary that are violative of the Constitution are invalid (declaratory relief), or that the court tin can prohibit the country from enforcing those portions of the law (injunctive relief).[44]

Eighteen states prohibit abortion after a sure number of weeks' gestation (usually 22 weeks from the terminal menstrual period).[41] The U.Due south. Supreme Court held in Webster v. Reproductive Health Services that a statute may create "a presumption of viability" after a sure number of weeks, in which instance the physician must be given an opportunity to rebut the presumption by performing tests.[45] Because this provision is not explicitly written into these state laws, as it was in the Missouri law examined in Webster, pro-option organizations believe that such a state law is unconstitutional, but only "to the extent that it prohibits pre-viability abortions".[46]

Ten states (although Florida'southward enforcement of such laws are under permanent injunction) require a second doctor'south approval before a late-term abortion tin can be performed.[41] The U.S. Supreme Court struck downward a requirement of "confirmation by two other physicians" (rather than one other medico) considering "acquiescence by co-practitioners has no rational connection with a patient's needs and disproportionately infringes on the physician's right to exercise".[47] Pro-choice organizations, such as the Guttmacher Found, posit that some of these land laws are unconstitutional, based on these and other Supreme Court rulings, at least to the extent that these land laws require approving of a 2nd or third doctor.[41]

Thirteen states accept laws that require a second medico to be nowadays during late-term abortion procedures in order to treat a fetus if born live.[41] The Court has held that a physician's right to practise is non infringed by requiring a second physician to exist nowadays at abortions performed after viability in order to assist in the case of a living fetus.[48] It is not mutual for alive infants to exist born after an abortion at any stage in pregnancy.[49]

Live birth [edit]

In 2019, a US Senate Bill entitled the "Built-in-Alive Abortion Survivors Protection Human action" raised the result of live nativity later on abortion.[50] [51] The pecker would mandate that medical providers resuscitate neonates delivered showing signs of life during an abortion process.[50] [51] During the fence effectually this issue, Us Republicans falsely alleged that medical providers "execute" live-born babies. Existing US laws would punish execution as homicide. Furthermore, United states abortion experts refute the claim that a "born-live" fetus is a common event and reject laws that would mandate resuscitation against the wishes of the parents.[51] [52]

Only one.3% of abortions occur later on 21 weeks of pregnancy in the US. Although information technology is very uncommon, women undergoing surgical abortion afterwards this gestational age sometimes requite birth to a fetus that may survive briefly.[53] [54] [55] The periviable menstruum is considered to be between 20 and 25 weeks gestation.[56] Long-term survival is possible afterwards 22 weeks.[57] Yet, odds of long-term survival between 22 and 23 weeks are 2–iii percentage and odds of survival between 23 and 24 weeks are 20 pct.[58] "Intact survival", which ways survival of a neonate without subsequent harm to organs such every bit the encephalon or bowel is one% at 22 weeks and 13% at 23 weeks.[58] Survival odds increase with increasing gestational age.[58]

If medical staff observe signs of life, they may exist required to provide care: emergency medical care if the child has a adept take a chance of survival and palliative care if not.[59] [sixty] [61] Induced fetal demise before termination of pregnancy subsequently 20–21 weeks gestation is recommended by some sources to avoid this and to comply with the US Partial Nascence Ballgame Ban.[62] [63] [64] [65] [66] Induced fetal demise does not improve the condom of an abortion procedure and may incur risks to the health of the woman having the abortion.[63]

Methods [edit]

There are at least four medical procedures associated with late-term abortions:

  • Dilation and evacuation (D&E)
  • Early labor induction (sometimes called "consecration abortion")
  • Intact dilation and extraction (IDX or D&10), sometimes referred to as "partial-birth ballgame"
  • Hysterotomy ballgame

References [edit]

  1. ^ Duke, C. Wes (September 2009). "Challenges and Priorities for Surveillance of Stillbirths: A Report on Two Workshops". Public Health Rep. 124 (5): 652–659. doi:10.1177/003335490912400507. PMC2728657. PMID 19753943.
  2. ^ Belluck, Pam (February 6, 2019). "What Is Late-Term Abortion? Trump Got It Wrong". The New York Times. Belatedly-term ballgame is a phrase used past ballgame opponents to refer to abortions performed after nearly 21 weeks of pregnancy. It is not the same equally the medical definition obstetricians use for 'late-term,' which refers to pregnancies that extend by a woman's due appointment, meaning nearly 41 or 42 weeks.
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  65. ^ "2015 Clinical Policy Guidelines" (PDF). National Abortion Federation. 2015. Archived (PDF) from the original on 12 Baronial 2015. Retrieved 30 October 2015. Policy Argument: Medical consecration abortion is a condom and effective method for termination of pregnancies beyond the first trimester when performed by trained clinicians in medical offices, freestanding clinics, ambulatory surgery centers, and hospitals. Feticidal agents may be particularly important when bug of viability arise.
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External links [edit]

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Source: https://en.wikipedia.org/wiki/Late_termination_of_pregnancy

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